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Lakes are threatened ecosystems in drylands of Central Asia. The Wuliangsuhai Lake ("W-Lake") is a case in point. Located in the Hetao Irrigation Area ("HIA"), W-Lake is a rare multifunctional inland lake in arid North China. It provides a wide range of ecosystem services, including provision of products, regulation of water and climate, water purification, biodiversity conservation and cultural services. The lake’s major water input is the drainage water from HIA’s farmlands. Those farmlands divert water directly from the Yellow River for irrigation. Unsustainable agricultural practice in HIA has gravely impacted on W-Lake in terms of reduced water quantity and degraded water quality. However, the linkage between agricultural practice in HIA and the environmental changes of W-Lake has been rarely investigated. Existing data focus mainly either on W-Lake or on HIA’s farmlands with overwhelmingly technical and end-of-the-pipe solutions. In view of the above, this paper develops four qualitative scenarios on HIA from social, economic and ecological perspectives. The four scenarios are: (a) green growth; (b) strong sustainability; (c) shift to swamp; and (d) worst case. The main aims of this paper are (1) to assist local decision makers of HIA in policy-making and (2) to develop concepts and strategies within the larger framework of integrated water management that shall inspire conservation efforts in other Central Asian regions.